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Research ArticleOriginal Research

Impact of a Novel Wellness Group Visit Model on Obesity and Behavior Change

Karen Axten, Kerri Hawkins, David J. Tybor, Josh Bernoff and Wayne Altman
The Journal of the American Board of Family Medicine November 2017, 30 (6) 715-723; DOI: https://doi.org/10.3122/jabfm.2017.06.170098
Karen Axten
From the Department of Family Medicine (KA, KH, JB, WA), Department of Public Health and Community Medicine (DJT), Tufts University School of Medicine (TUSM), Boston, MA.
BA
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Kerri Hawkins
From the Department of Family Medicine (KA, KH, JB, WA), Department of Public Health and Community Medicine (DJT), Tufts University School of Medicine (TUSM), Boston, MA.
RD, CPT
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David J. Tybor
From the Department of Family Medicine (KA, KH, JB, WA), Department of Public Health and Community Medicine (DJT), Tufts University School of Medicine (TUSM), Boston, MA.
PhD, MPH
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Josh Bernoff
From the Department of Family Medicine (KA, KH, JB, WA), Department of Public Health and Community Medicine (DJT), Tufts University School of Medicine (TUSM), Boston, MA.
BS
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Wayne Altman
From the Department of Family Medicine (KA, KH, JB, WA), Department of Public Health and Community Medicine (DJT), Tufts University School of Medicine (TUSM), Boston, MA.
MD, FAAFP
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Article Figures & Data

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    Figure 1.

    Patient weight change before and after WGs. The average total weight loss for a WG patient during the group (including first group and subsequent groups if they participated) was 20.1 pounds (168 patients, 3377 pounds). These 168 patients regained 1167 of the 3377 pounds between and after all their WGs. So, WG patients regained an average of 6.9 pounds (of the 20.1 pounds lost during the program).

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    Table 1.

    Demographics of Survey Respondents

    WGComparison Group
    Race
        Caucasian7562
        Asian55
        African American13
    Education
        High school diploma or equivalent26
        Associate’s degree106
        Some college, no degree410
        Bachelor’s degree2616
        Master’s degree2524
        Doctoral or professional degree168
    Marital status
        Married6154
        Divorced/separated87
        Single1011
    Income
        Less than $25,00023
        $25,000 to $49,999812
        $50,000 to $74,99998
        $75,000 to $99,999147
        $100,000 to $149,9991618
        $150,000 to $249,9992612
        $250,000 -to $499,999124
        $500,000 or more01
    Kids at home (average)0.580.87
    • WG, wellness group.

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    Table 2.

    Treatment Group Relative to Comparison Group Differences in Retrospective Self-Reported 3-Month Behavior Change, Ordinal Logistic Regression (Dependent Variable Likert Scale 1 to 5)

    Survey QuestionOdds Ratio For Treatment Group Relative to Comparison Group (95% CI)P Value
    Read nutrition facts on food labels13.8 (6.7 to 28.6)< .05
    Eat more fruits and vegetables7.2 (3.7 to 14.2)< .05
    Feel “stuffed” less often6.6 (3.4 to 13.0)< .05
    Walk more steps daily5.3 (2.8 to 10.2)< .05
    Eat more whole grains4.8 (2.5 to 9.0)< .05
    Incorporate stress management4.4 (2.3 to 8.4)< .05
    Increase hours of sleep4.2 (2.1 to 8.4)< .05
    Eat less beef4.2 (2.2 to 8.3)< .05
    Eat less frequently in front of screens2.7 (1.4 to 5.3)< .05
    Eat more slowly2.7 (1.4 to 5.1)< .05
    Exercise more2.6 (1.4 to 4.7)< .05
    Eat more home-cooked meals1.9 (1.1 to 3.5)< .05
    Put effort into improving health before intervention0.5 (0.3 to 0.9)< .05
    • CI, confidential interval.

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    Table 3.

    Demographics and Baseline Numbers of the Treatment and Comparison Groups Pertaining to Medical Chart Data

    WG (n = 99)Comparison Group (n = 190)
    MaleFemaleMaleFemale
    Age (years)50.3153.6349.7951.62
    SexN = 43N = 56N = 78N = 112
    BMI (kg/m2)37.6435.4333.8633.68
    Weight (pounds)229.70212.05
    SBP (mm Hg)130.07123.55
    DBP (mm Hg)79.8478.51
    A1c (%)6.355.85
    HDL (mg/dL)51.1755.03
    LDL (mg/dL)108.11118.96
    Total cholesterol (mg/dL)190.54201.68
    Triglycerides (mg/dL)173.95154.59
    • BMI, body mass index; DBP, diastolic blood pressure; HDL, high-density lipoprotein; LDL, low-density lipoprotein; WG, wellness group; SBP, systolic blood pressure.

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    Table 4.

    Physiological Changes at Least 1 Year After Intervention Compared with the Day of the First Wellness Group (WG) Session (Treatment Group) or the Day of the Annual Physical (Comparison Group)

    Variable (n)nTreatment (mean, [SD])Comparison (mean [SD])Raw Difference Between Groups (Treatment–Comparison)Difference Adjusting for Baseline BMI
    Weight change (pounds)274−13.21 (20.6)+1.94 (20.3)−15.15*−12.53*
    BMI (kg/m2)268−2.21 (3.2)+0.30 (3.3)−2.51*−1.88*
    Systolic BP (mm Hg)277−6.96 (14.5)−1.13(14.0)−5.83*−1.78
    Diastolic BP (mm Hg)277−5.70 (10.0)−4.20 (11.0)−1.500.70
    Hemoglobin A1c (%)86+0.18 (0.9)−0.01 (0.7)0.160.13
    HDL (mg/dL)106+2.81 (7.5)+0.63 (6.8)2.182.12
    LDL (mg/dL)96−0.42 (23.8)−5.00 (22.6)4.582.58
    Total cholesterol (mg/dL)104−3.23 (24.0)−8.54 (30.6)5.312.45
    Triglycerides (mg/dL)88−34.27 (70.9)−5.03 (72.5)−29.24−25.85
    • ↵* P < .05, Independent samples t-test comparing change in treatment group to change in comparison group.

    • BMI, body mass index; BP, blood pressure; HDL, high-density lipoprotein; LDL, low-density lipoprotein; SD, Standard Deviation.

    • View popup
    Table 5.

    Weight Loss (WG) of WG Patients

    Sample Size (n)Mean Δ Weight (pounds) During Wellness Group Program (WG)*Mean Δ Weight (pounds) After Program Completed†Number of Patients Who Lost Clinically Relevant Weight‡Patients Who Lost Significant Weight (%)‡% of Patients Who Lost Significant Weight and Maintained ≥50% of Weight Loss§
    All (WG) patients168−16.63.510361%73%
    All WG patients weighed ≥1 year after completing WG program105−18.44.37067%69%
    WG Patients weighed ≥1 year after completing WG program (only 1 program)60−16.17.03558%54%
    WG patients weighed ≥1 year after completing WG program (>1 program)45−21.60.63578%83%
    All WG patients weighed ≥3 years after completing WG program50−18.53.33570%71%
    • ↵* Weight at last session of program minus weight at first session of program (first program if completed multiple programs).

    • ↵† Most up-to-date weight on record minus weight at last session of program (first program if completed multiple programs).

    • ↵‡ At least 5% of weight at start of first WG.

    • ↵§ Based on most up-to-date weight and weight at last session of program (first program if completed multiple programs).

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The Journal of the American Board of Family     Medicine: 30 (6)
The Journal of the American Board of Family Medicine
Vol. 30, Issue 6
November-December 2017
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Impact of a Novel Wellness Group Visit Model on Obesity and Behavior Change
Karen Axten, Kerri Hawkins, David J. Tybor, Josh Bernoff, Wayne Altman
The Journal of the American Board of Family Medicine Nov 2017, 30 (6) 715-723; DOI: 10.3122/jabfm.2017.06.170098

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Impact of a Novel Wellness Group Visit Model on Obesity and Behavior Change
Karen Axten, Kerri Hawkins, David J. Tybor, Josh Bernoff, Wayne Altman
The Journal of the American Board of Family Medicine Nov 2017, 30 (6) 715-723; DOI: 10.3122/jabfm.2017.06.170098
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